Published online Jun 19, 2026. doi: 10.5498/wjp.v16.i6.116328
Revised: January 8, 2026
Accepted: March 4, 2026
Published online: June 19, 2026
Processing time: 174 Days and 0.8 Hours
Post-intervention depression with psychotic features represents a severe com
To investigate the value of human chitinase-3-like protein 1 (YKL-40/CHI3L1), high-sensitivity C-reactive protein, and interleukin-6 in predicting psychotic complications of postoperative depression following cerebrovascular intervention.
General patient data from 94 patients who underwent cerebrovascular inter
Univariate and multivariate logistic regression analyses identified YKL-40 levels on postoperative day 3, National Institute of Health Stroke Scale scores on pos
YKL-40 demonstrated good predictive efficacy for psychotic complications of depression following cerebrovascular intervention. Dynamic monitoring of YKL-40 can facilitate early identification of high-risk patients and enable timely, effective interventions.
Core Tip: This article of 94 patients undergoing cerebrovascular intervention identified postoperative day 3 serum human chitinase-3-like protein 1 level, postoperative day 7 National Institute of Health Stroke Scale score, and intraoperative complications as independent risk factors for depressive disorder with psychotic complications. Human chitinase-3-like protein 1 demonstrated superior predictive value (area under the curve = 0.892) compared to interleukin-6 and high-sensitivity C-reactive protein, and its levels correlated significantly with Hamilton Depression Rating Scale-17 and Positive and Negative Syndrome Scale positive subscale scores, highlighting its potential as a robust biomarker for early identification of high-risk patients.
- Citation: Yang F, Zhou RJ, Xu W, Li Y, Luan DH, Xu MY. Value of inflammatory markers in predicting psychotic complications of postoperative depression after cerebrovascular intervention. World J Psychiatry 2026; 16(6): 116328
- URL: https://www.wjgnet.com/2220-3206/full/v16/i6/116328.htm
- DOI: https://dx.doi.org/10.5498/wjp.v16.i6.116328
Cerebrovascular diseases are among the leading causes of death and long-term disability worldwide, characterized by high incidence and high disability rates, imposing a heavy burden on society and families[1,2]. With the rapid advancement of neurointerventional techniques, endovascular procedures, such as intravascular stenting, aneurysm coiling, and mechanical thrombectomy, for acute ischemic stroke offer advantages such as minimal invasiveness and faster recovery, and these procedures have become key methods for treating intracranial arterial stenosis, aneurysms, cerebrovascular malformations, and other conditions[3,4]. In recent years, increasing clinical observations and studies have indicated that patients undergoing cerebrovascular interventions are a high-risk group for mental and psychological disorders. Notably, the incidence of postoperative depression and its related psychotic complications - such as hallucinations, delusions, anxiety, and agitation - is relatively high. These complications severely affect patients’ quality of life, treatment compliance, and neurological rehabilitation progress and can also lead to extreme behaviors, such as self-harm or suicide, significantly impacting long-term quality of life and survival rates[5,6]. Currently, the identification of postoperative depressive disorder with psychotic complications in clinical practice primarily relies on psychiatric interviews and scale assessments by psychiatrists, which are subjective and often only diagnose the condition after obvious symptoms appear, lacking objective and quantifiable early warning indicators[7,8].
In recent years, research into the pathophysiological mechanisms of postoperative psychiatric complications has expanded beyond the direct effects of neuroinflammation to encompass a multisystem interaction perspective. Research indicates that the systemic inflammatory response triggered by surgical trauma and ischemia-reperfusion injury may activate the “gut-brain axis” signaling pathways by impairing intestinal barrier function, altering gut microbiota composition, and increasing intestinal permeability. This subsequently impacts immune homeostasis and neurotransmitter balance within the central nervous system. Concurrently, peripheral immune cell infiltration into the central nervous system and inflammation-mediated metabolic pathway dysregulation (such as the shift of the tryptophan-kynurenine pathway towards neurotoxic products) are also recognized as key mechanisms contributing to postoperative depression and cognitive impairment[9]. These findings suggest that postoperative psychiatric complications may result from the combined effects of neuroinflammation, peripheral immunity, metabolic alterations, and the intestinal microenvironment. Therefore, in-depth exploration of the association between inflammatory markers and these systemic pathophysiological processes contributes to a more comprehensive understanding of the mechanisms underlying postoperative psychiatric symptoms and also provides a theoretical basis for constructing multidimensional predictive models[10].
Therefore, exploring biological markers capable of early and objective prediction of the occurrence of postoperative depressive disorder with psychotic complications is of paramount clinical importance for achieving early identification of high-risk patients, enabling early intervention, and improving prognosis. In light of this, this study, employing a retrospective analysis method, systematically investigated the clinical value of inflammatory markers, including serum high-sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, and human chitinase-3-like protein 1 (YKL-40/CHI3 L1) in predicting depression and psychotic complications after cerebrovascular intervention. The aim was to provide a reference for the early identification of high-risk patients and the implementation of targeted preventive strategies in clinical practice, thereby promoting improved patient outcomes.
Approved by the hospital ethics committee, the clinical data of 94 patients who underwent cerebrovascular intervention at our hospital between January 2023 and June 2025 were retrospectively analyzed. Inclusion criteria: (1) Age ≥ 18 years; (2) Undergoing cerebrovascular intervention for the first time, meeting relevant surgical indications; (3) Complete clinical record data, including preoperative and postoperative inflammatory marker tests; and (4) Postoperative survival time ≥ 3 months and completion of at least one standardized psychiatric follow-up assessment. Exclusion criteria: (1) Pre-existing diagnosed psychiatric disorders such as depression, schizophrenia, bipolar disorder, or dementia; (2) Use of corticosteroids, immunosuppressants, antipsychotics, or antidepressants within 3 months prior to surgery; (3) Accompanied by severe systemic infection, malignant tumors, autoimmune diseases, or end-stage hepatic/renal insufficiency; and (4) Inability to cooperate with psychiatric assessment due to severe aphasia, consciousness disorders, etc.
Based on the 3-month postoperative follow-up assessment results, using the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition[9], the patients diagnosed by psychiatrists with “Depressive Disorder with Psychotic Features” were included in the observation group (n = 28), and the remaining patients were included in the control group (n = 66).
General data: Age, gender, body mass index, smoking history, alcohol history, history of hypertension, diabetes, hyperlipidemia, preoperative diagnosis (e.g., cerebral infarction, transient ischemic attack, unruptured aneurysm, etc.), surgical type, operation duration, anesthesia method.
Laboratory indicators: Fasting venous blood (5 mL) was collected from all patients one day before surgery and on postoperative day 1, days 3, and days 7. After serum separation, the IL-6 and YKL-40 levels were detected using enzyme-linked immunosorbent assay, and hs-CRP levels were detected using immunoturbidimetry.
Psychiatric assessment: Scores from the Hamilton Depression Rating Scale-17 (HAMD-17) and the Positive and Negative Syndrome Scale (PANSS) during the postoperative follow-up period were recorded.
Data were analyzed using SPSS 26.0 software. Measurement data conforming to a normal distribution are expressed as mean ± SD and compared using the independent samples t-test; those not conforming to a normal distribution are expressed as medians with interquartile ranges (median, P25, P75) and compared using the Mann-Whitney U test (statistic: Z value). Count data are expressed as n (%) and compared using the χ2 test or Fisher’s exact test. Indicators showing statistical significance in univariate analysis were included in multivariate unconditional logistic regression analysis. A P value < 0.05 was considered statistically significant.
Among the 94 patients in this study, 28 (29.8%) developed depressive disorder with psychotic features postoperatively. Univariate analysis showed that the observation group had significantly higher preoperative National Institute of Health Stroke Scale (NIHSS) scores, the modified Rankin Scale (mRS) scores, HAMD-17 scores, operation duration, intraoperative complication rate, postoperative day 7 NIHSS scores, mRS scores, and levels of inflammatory markers (hs-CRP, IL-6, YKL-40) on postoperative day 1, days 3, and days 7 compared to the control group (P < 0.05) (Table 1).
| Variable | Overall (n = 94) | Observation group (n = 28) | Control group (n = 66) | Statistic | P value |
| Age (years), mean ± SD | 64.0 ± 9.3 | 65.8 ± 8.9 | 63.1 ± 9.5 | t = 1.325 | 0.188 |
| Male | 56 (59.6) | 16 (57.1) | 40 (60.6) | χ2 = 0.102 | 0.749 |
| BMI (kg/m2), mean ± SD | 23.8 ± 3.0 | 24.1 ± 2.8 | 23.7 ± 3.1 | t = 0.597 | 0.552 |
| Hypertension | 62 (66.0) | 20 (71.4) | 42 (63.6) | χ2 = 0.527 | 0.468 |
| Diabetes | 27 (28.7) | 9 (32.1) | 18 (27.3) | χ2 = 0.231 | 0.631 |
| Hyperlipidemia | 35 (37.2) | 12 (42.9) | 23 (34.8) | χ2 = 0.536 | 0.464 |
| Smoking history | 38 (40.4) | 13 (46.4) | 25 (37.9) | χ2 = 0.579 | 0.447 |
| Alcohol history | 31 (33.0) | 10 (35.7) | 21 (31.8) | χ2 = 0.136 | 0.712 |
| Preop NIHSS score | 4 (2, 7) | 6 (4, 9) | 3 (1, 5) | Z = 3.891 | < 0.001 |
| Preop mRS score ≥ 2 | 31 (33.0) | 14 (50.0) | 17 (25.8) | χ2 = 5.432 | 0.020 |
| Preop HAMD-17 score | 5 (3, 7) | 6 (4, 8) | 4 (2, 6) | Z = 2.987 | 0.003 |
| Operation duration (minute) | 120 (90, 165) | 145 (110, 185) | 110 (85, 150) | Z = 2.456 | 0.014 |
| Intraoperative complications | 11 (11.7) | 7 (25.0) | 4 (6.1) | Fisher | 0.016 |
| Contrast volume (mL), mean ± SD | 145.6 ± 35.2 | 152.3 ± 38.1 | 142.5 ± 33.5 | t = 1.287 | 0.201 |
| Postop day 7 NIHSS score | 3 (1, 5) | 5 (3, 7) | 2 (1, 4) | Z = 4.215 | < 0.001 |
| Postop day 7 mRS score ≥ 2 | 48 (51.1) | 21 (75.0) | 27 (40.9) | χ2 = 9.012 | 0.003 |
| Preoperative inflammatory markers | |||||
| hs-CRP (mg/L) | 2.0 (1.4, 2.9) | 2.1 (1.5, 3.0) | 1.9 (1.3, 2.8) | Z = 0.891 | 0.373 |
| IL-6 (pg/mL) | 8.1 (6.0, 10.8) | 8.5 (6.1, 11.2) | 7.8 (5.9, 10.5) | Z = 0.765 | 0.444 |
| YKL-40 (ng/mL) | 56.3 (43.9, 70.2) | 58.3 (45.6, 72.1) | 55.1 (42.8, 69.5) | Z = 0.812 | 0.417 |
| Postop day 1 inflammatory markers | |||||
| hs-CRP (mg/L) | 11.9 (8.5, 15.8) | 15.8 (12.1, 20.5) | 10.2 (7.5, 13.6) | Z = 4.521 | < 0.001 |
| IL-6 (pg/mL) | 26.2 (19.5, 34.8) | 35.6 (28.4, 45.1) | 22.3 (16.8, 29.7) | Z = 5.012 | < 0.001 |
| YKL-40 (ng/mL) | 96.5 (72.3, 120.8) | 125.6 (98.8, 155.3) | 85.4 (65.2, 105.7) | Z = 4.876 | < 0.001 |
| Postop day 3 inflammatory markers | |||||
| hs-CRP (mg/L) | 14.2 (10.5, 18.9) | 18.9 (15.2, 24.1) | 12.4 (9.1, 16.0) | Z = 5.234 | < 0.001 |
| IL-6 (pg/mL) | 33.5 (24.8, 43.1) | 48.9 (39.8, 60.5) | 28.1 (21.5, 35.9) | Z = 5.678 | < 0.001 |
| YKL-40 (ng/mL) | 125.6 (92.4, 158.9) | 189.5 (160.2, 225.8) | 102.8 (80.1, 125.6) | Z = 6.102 | < 0.001 |
| Postop day 7 inflammatory markers | |||||
| hs-CRP (mg/L) | 7.5 (5.3, 9.8) | 10.5 (7.8, 14.2) | 6.3 (4.5, 8.1) | Z = 4.897 | < 0.001 |
| IL-6 (pg/mL) | 18.2 (13.5, 23.1) | 25.3 (19.8, 32.0) | 15.1 (11.2, 19.5) | Z = 5.145 | < 0.001 |
| YKL-40 (ng/mL) | 95.8 (70.1, 120.5) | 142.1 (115.4, 175.9) | 78.9 (62.3, 98.4) | Z = 5.564 | < 0.001 |
All variables with P < 0.05 in the univariate analysis were included as independent variables, with the occurrence of depressive disorder with psychotic complications as the dependent variable. To avoid multicollinearity, variance inflation factor diagnostics were performed on continuous variables; all variance inflation factor values were < 5, indicating acceptable collinearity. Multivariate logistic regression analysis was conducted using the backward stepwise method (likelihood ratio test), with a removal criterion of P > 0.10. Ultimately, three variables were retained in the final model as independent risk factors for postoperative depressive disorder with psychotic complications (P < 0.05): YKL-40 level on postoperative day 3, NIHSS score on postoperative day 7, and intraoperative complications (Table 2).
| Variable | β coefficient | SE | Wald χ² value | P value | OR | 95%CI for OR |
| Postop day 3 YKL-40 (per 1 ng/mL increase) | 0.018 | 0.006 | 9.002 | 0.003 | 1.018 | 1.006-1.030 |
| Postop day 7 NIHSS score (per 1 point increase) | 0.421 | 0.152 | 7.672 | 0.006 | 1.523 | 1.131-2.051 |
| Intraoperative complications | 1.587 | 0.721 | 4.844 | 0.028 | 4.892 | 1.192-20.081 |
| Constant | -10.524 | 2.893 | 13.241 | < 0.001 | 0.000 | - |
Receiver operating characteristic (ROC) curve analysis indicated that the inflammatory markers measured on postoperative day 3 had the highest predictive value. Among them, YKL-40 had the largest area under the curve (AUC) of 0.892 (95% confidence interval: 0.821-0.963), with an optimal cut-off value of 156.4 ng/mL, yielding a sensitivity of 85.7% and a specificity of 84.8%. The AUCs for IL-6 and hs-CRP were 0.835 and 0.798, respectively (Figure 1 and Table 3).
| Indicator | AUC | 95%CI | Optimal cut-off value | Sensitivity (%) | Specificity (%) | P value |
| YKL-40 | 0.892 | 0.821-0.963 | 156.4 ng/mL | 85.7 | 84.8 | < 0.001 |
| IL-6 | 0.835 | 0.745-0.925 | 36.8 pg/mL | 82.1 | 80.3 | < 0.001 |
| hs-CRP | 0.798 | 0.698-0.898 | 15.1 mg/L | 78.6 | 75.8 | < 0.001 |
Spearman correlation analysis revealed that YKL-40 levels on postoperative day 3 in the complication group were significantly positively correlated with both HAMD-17 scores (r = 0.612, P < 0.001) and PANSS positive subscale scores (r = 0.584, P < 0.001) (Figure 2).
As an important method for treating intracranial arterial stenosis, aneurysms, acute ischemic stroke, and other conditions, cerebrovascular intervention has been widely adopted in recent years due to its minimally invasive and highly effective characteristics[10-12]. However, surgical success entails more than just anatomical vascular repair; long-term neurological recovery and mental health are equally crucial and represent core dimensions for measuring overall treatment efficacy[13,14]. Depressive disorder with psychotic features is a common and serious complication following cerebrovascular intervention. Its pathogenesis is complex, involving biological, psychological, and social factors. It significantly reduces patients' quality of life and adversely affects their neurological recovery, prolongs the rehabilitation period, and increases the burden on society and families[15,16]. This study revealed an incidence of depressive disorder with psychotic features within three months postoperatively of 29.8%, which is consistent with reported rates of postoperative psychiatric complications in the literature[17], highlighting the prevalence and severity of this issue.
Previous research often explained these phenomena from perspectives such as psychological stress response, direct effects of the primary brain lesion, postoperative social role changes, and weak family support systems. However, these factors often fail to fully explain why a high proportion of psychiatric disorders still occur in patients with successful surgeries and significant improvement in neurological deficits. The neuroinflammation hypothesis provides a new perspective for understanding this phenomenon. Studies have indicated[18,19] that when the central nervous system is stimulated by surgical manipulation, ischemia-reperfusion injury, contrast agent toxicity, and microemboli, it rapidly activates microglia and astrocytes, initiating a complex inflammatory cascade and releasing large amounts of pro-inflammatory cytokines. These cytokines directly damage neurons and also disrupt the blood-brain barrier, affect the synthesis and metabolism of neurotransmitters, inhibit the expression of neurotrophic factors, and ultimately lead to dysfunction of limbic system structures, such as the hippocampus and prefrontal cortex, thereby inducing psychiatric symptoms like depression and anxiety. To further explore the mechanisms underlying postoperative depressive disorder with psychotic complications after cerebrovascular intervention, this study systematically detected and analyzed relevant inflammatory markers, aiming to identify biomarkers that can sensitively and specifically reflect the state of central neuroinflammation, thereby providing a reliable basis for the early identification and intervention of postoperative psychiatric disorders.
Univariate and multivariate logistic regression analyses identified YKL-40 level on postoperative day 3, NIHSS score on postoperative day 7, and intraoperative complications as independent risk factors for postoperative depressive disorder with psychotic complications (P < 0.05). In-depth analysis suggested the following possible reasons: (1) YKL-40 is a glycoprotein primarily secreted by activated macrophages, neutrophils, and activated astrocytes, playing a key role in central nervous system inflammatory responses, tissue repair, and fibrosis, as confirmed by numerous studies[20,21]. Research has shown[22] that cerebrospinal fluid and serum YKL-40 levels are significantly elevated in various neurological diseases, such as Alzheimer’s disease, multiple sclerosis, Parkinson’s disease, and ischemic stroke, and are associated with disease severity and poor prognosis. The elevated YKL-40 level on postoperative day 3 after cerebrovascular intervention may be due to surgical stimulation, triggering central nervous system inflammation, and activating relevant cells to secrete YKL-40. High levels of YKL-40 can increase the risk of depressive disorder with psychotic complications through various pathways, including participating in the disruption of the blood-brain barrier, altering permeability, activating microglia, and interfering with normal neurotransmitter metabolism[23]; (2) The NIHSS score on postoperative day 7 reflects the degree of neurological deficit; a higher score indicates more severe neurological impairment, which can exacerbate psychiatric symptoms via inflammatory pathways[24]. Severe neurological deficits lead to reduced self-care ability, increased psychological stress, and anxiety and fear about the future. Furthermore, neurological impairment may affect the normal function of brain regions involved in emotion regulation, such as connections and signaling in the limbic system and prefrontal cortex, thereby increasing the likelihood of depressive disorder with psychotic complications; and (3) Intraoperative complications, such as vasospasm, thrombosis, or hemorrhage, further aggravate brain damage and ischemic-hypoxic states, leading to neuronal death and worsened neurological function, as well as triggering a stronger inflammatory response and the release of more inflammatory mediators[25,26]. The intensified inflammatory response disrupts the neuronal microenvironment, affects the balance of neurotransmitters and neural signal transmission, and ultimately, promotes the occurrence of depressive disorder with psychotic complications. These findings are consistent with studies such as that of Wilent et al[27], emphasizing the importance of intraoperative monitoring and postoperative neurological assessment.
Meanwhile, ROC curve analysis results showed that the inflammatory markers measured on postoperative day 3 had the highest predictive value. Among them, YKL-40 had the largest AUC of 0.892 (95% confidence interval: 0.821-0.963), while the AUCs for IL-6 and hs-CRP were 0.835 and 0.798, respectively. This clearly demonstrated that the inflammatory markers on postoperative day 3 have high predictive value for postoperative depressive disorder with psychotic complications, with YKL-40 exhibiting the most prominent predictive capability. The reason for this may be that the inflammatory response is rapidly initiated early after cerebrovascular intervention, and YKL-40, as a sensitive indicator of the inflammatory response, can rapidly and significantly reflect the inflammatory state in the central nervous system. Compared to traditional inflammatory markers like hs-CRP and IL-6, YKL-40 is closely related to the activation state of astrocytes, more accurately reflecting the level of inflammation within the central nervous system. Furthermore, its relatively longer half-life and smaller degree of fluctuation make it more stable for reflecting chronic or subclinical inflammatory states; therefore, it is more suitable as a dynamic monitoring indicator. Therefore, YKL-40 has unique advantages in predicting postoperative depressive disorder with psychotic complications. Additionally, Spearman correlation analysis showed that YKL-40 levels on postoperative day 3 in the complication group were significantly positively correlated with both HAMD-17 scores and PANSS positive subscale scores (P < 0.05), further confirming the association between neuroinflammation and depressive/psychotic symptoms. Higher YKL-40 levels may indicate more severe depressive and psychotic symptoms. This finding echoes case reports such as those by Castellana et al[28] on inflammatory activation in psychotic depression, which suggest that anti-inflammatory therapy might be a future intervention direction. ROC curve analysis indicated that inflammatory markers on postoperative day 3 demonstrate high predictive value for postoperative depression with psychotic complications, with YKL-40 exhibiting particularly outstanding predictive efficacy (AUC = 0.892), surpassing IL-6 and hs-CRP. This indicates that YKL-40 possesses statistically superior discriminatory capability, and its relatively long half-life and minimal fluctuation also render it more suitable as a stable indicator for dynamic monitoring. In clinical practice, YKL-40 monitoring may be incorporated into routine postoperative inflammatory assessment systems, particularly for early screening in high-risk patients (e.g., those with significant preoperative neurological deficits or intraoperative complications). It is recommended that YKL-40 be measured on the third postoperative day. Should levels exceed 156.4 ng/mL, vigilance for psychotic complications is warranted, prompting initiation of multidisciplinary assessment and intervention protocols.
To further enhance the clinical applicability of predictive models, future research may explore integrating YKL-40 with clinical parameters, such as NIHSS scores and intraoperative complications, to develop a comprehensive risk scoring system. For instance, YKL-40 levels could be stratified (e.g., < 120 ng/mL, 120-180 ng/mL, > 180 ng/mL), and weighting variables such as NIHSS change trends and surgical duration could be included to create a simplified clinical decision-making aid. Furthermore, dynamically monitoring YKL-40 trends within the first postoperative week may offer greater predictive value than single-time-point assessment, particularly for patients exhibiting persistently escalating inflammatory responses. Even if individual cut-off values remain unmet, an upward trajectory may indicate accumulating risk.
At the intervention level, patients exhibiting sustained YKL-40 elevation warrant consideration for early anti-inflammatory therapy (e.g., non-steroidal anti-inflammatory drugs, targeted immunomodulators) alongside enhanced psychological support. Concurrently, the dynamic changes in YKL-40 serve as a biomarker for intervention efficacy, facilitating assessment of treatment response and adjustment of management strategies. This enables a closed-loop management approach of “monitoring-early warning-intervention-reassessment”, advancing the prevention and treatment of postoperative psychiatric complications toward precision and individualization.
This study confirmed that serum YKL-40 demonstrates good predictive efficacy for post-cerebrovascular intervention depression with psychotic complications; however, its widespread adoption in clinical practice faces several challenges. Currently, YKL-40 testing is not a routine procedure in neurology or psychiatry departments. Factors such as standardized testing protocols, cost-effectiveness, and turnaround time for results may impede its clinical implementation. To facilitate the transition of YKL-40 from a biomarker to a clinically useful tool, future research and practical exploration should focus on the following areas: First, efforts must be made to standardize and streamline YKL-40 testing. It is recommended to initiate multi-center collaborations to unify testing methods and threshold criteria while assessing their applicability across different populations. Concurrently, developing rapid, cost-effective detection technologies (such as point-of-care testing devices) would enhance clinical accessibility. Second, strategies for integrating YKL-40 with existing clinical assessment tools should be explored. For instance, dynamic monitoring of YKL-40 could be combined with psychosocial scales, such as the Patient Health Questionnaire-9 and Hospital Anxiety and Depression Scale, forming a multidimensional assessment model of ‘biomarker + clinical scale’. Building upon this, establishing a multimodal predictive scoring system integrating inflammatory markers (e.g., YKL-40, IL-6, hs-CRP) with clinical variables (e.g., NIHSS scores, intraoperative complications) holds promise for further improving the accuracy and practicality of early risk stratification. Finally, targeted intervention studies should be conducted. For patients exhibiting persistently elevated YKL-40 levels alongside other high-risk factors, comprehensive management strategies combining early anti-inflammatory treatment (e.g., non-steroidal anti-inflammatory drugs, inflammation pathway-targeted medications) with psychological interventions should be explored, alongside evaluating their practical efficacy in preventing psychotic complications. In summary, integrating inflammatory markers such as YKL-40 into postoperative management pathways to achieve a closed-loop transition from ‘prediction’ to ‘intervention’ represents a crucial direction for improving psychosocial outcomes following cerebrovascular interventions. Future prospective, practical clinical trials are required to validate their value and feasibility within real-world clinical pathways.
In clinical practice, active monitoring of inflammatory markers like YKL-40 after cerebrovascular intervention should be implemented, combined with postoperative NIHSS scores and the occurrence of intraoperative complications, to conduct early assessment of the risk of developing depressive disorder with psychotic complications. Particularly for high-risk patients with high YKL-40 levels, high NIHSS scores, or intraoperative complications, early and rational use of anti-inflammatory medications should be considered postoperatively to reduce central nervous system inflammation. Enhanced postoperative mental state monitoring and interventions, such as cognitive-behavioral therapy and supportive psychotherapy, should be combined to help patients alleviate psychological stress and enhance their ability to cope with the disease. Simultaneously, strengthening health education for patients’ families, improving their awareness and attention to postoperative psychiatric complications, providing patients with more care and support, and creating a favorable family rehabilitation environment are crucial.
It is noteworthy that, in recent years, the potential of other immune-inflammatory markers in predicting neuropsychiatric disorders has also garnered increasing attention. For instance, the neutrophil-to-lymphocyte ratio, as an easily accessible systemic inflammatory marker, has been found to correlate with depression severity and the risk of postoperative delirium; the monocyte-to-high-density lipoprotein cholesterol ratio reflects the interplay between inflammation and lipid metabolism, demonstrating predictive value in cardiovascular events and post-stroke affective disorders; and soluble triggering receptor-like protein 1, a novel marker of innate immune activation, is increasingly implicated in central nervous system inflammation and psychopathological mechanisms. Compared to specific central inflammatory markers such as YKL-40, the aforementioned indicators are more readily obtainable through routine blood tests and may reflect systemic or neuroimmune status from different perspectives. Future research could further compare the predictive efficacy of these biomarkers vs YKL-40 in post-cerebrovascular intervention psychiatric complications, or attempt to construct a comprehensive predictive system incorporating multidimensional immune-inflammatory indicators. This would provide clinicians with richer, more practical risk assessment tools.
However, this study was a single-center retrospective design with limitations such as a limited sample size and insufficient depth in exploring inflammatory pathway mechanisms. Further multi-center, large-sample prospective studies are needed to strengthen research on inflammatory pathways and clarify the specific mechanisms of action between inflammatory markers and depressive disorder with psychotic complications, thereby providing more precise targets for clinical treatment.
Although this study primarily examined the predictive value of inflammatory markers for postoperative psychiatric complications, it did not encompass other potential influencing factors, such as preoperative comorbidities, social support systems, psychological resilience, medication history, and family environment. These factors may interact with the inflammatory response to jointly influence the onset and progression of depressive and psychotic symptoms. Future research should systematically collect and integrate these multidimensional variables, constructing comprehensive predictive models incorporating bio-psycho-social factors to enhance early identification of high-risk patients. Furthermore, combining data analysis methods such as machine learning holds promise for achieving individualized risk assessment and stratified interventions, thereby optimizing management strategies for postoperative mental health outcomes.
In summary, the serum level of the inflammatory marker YKL-40 demonstrated good predictive efficacy for psychotic complications of depression following cerebrovascular intervention. Dynamic monitoring of YKL-40 should be enhanced to facilitate early identification of high-risk patients and enable timely, effective interventions.
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